DESIGNING & BUILDING EFFEC TIVE SCENARIOS
SUPPORTING SAFETY 2
Simulation activities supporting behavioral health & pediatric
patients, appropriate stretcher use & reducing drug errors
By Jennifer McCarthy, MAS, NRP, MICP, CHSE; Amar P. Patel, DHSc, MS, NRP;
Andrew E. Spain, MA, NCEE, EMT-P & Timothy Whitaker, BS, CHSE, CHSOS, EMT-P
In the December column, three of the 10 topics identified as patient and provider safety issues by the Center for Patient Safety’s EMS Forward initiative1 were discussed
and simple objectives with associated simulation activities were provided to help you understand how simulation can support patient safety.
This month we continue the discussion by addressing four additional
topics and explore how simulation can
support addressing each, thus working to improve patient and provider
safety and outcomes.
Although behavioral health emergencies serve as a small percentage
of overall EMS patient interactions, emergency care providers influence patient outcomes; therefore, behavioral health simulation
is important within EMS education.
All EMS activations involve an emotional
response (i.e., stress)—a response providers
often become desensitized to, which is one reason that scene safety considerations should be
paramount in all simulation scenarios. Behavioral emergencies often come with an unpredictable or heightened emotional response—and
with it an increased safety risk.
Many education programs allow learners to
verbalize both body substance isolation (BSI)
and scene safety at the beginning of a scenario
without promoting an actual assessment for
safety and assessment of the emotion at the
scene. From an educational perspective, sim-
ulation activities can be designed to help stu-
dents understand how to manage patients with
behavioral health issues and should require stu-
dents do more do more than simply verbalize
To do this effectively, educators should
consider using standardized patients (SPs) as
the medium to deliver the activity, as well as
standardized embedded participants (SEPs) to
set up the environment and provide a realistic
immersive experience for students.
SPs are live individuals—often called
“actors”—who play the role of a patient. They’re
trained to exhibit specific and consistent behaviors and provide responses based on provider
3 SPs can be trained to mimic a variety of behavioral health presentations, and to
respond positively or negatively depending
on whether students choose appropriate ways
to de-escalate and engage patients with
Similarly, SEPs are live individuals who play
the role of someone other than the patient: family members, law enforcement, or anyone else
who might influence the way a student handles
a particular scenario. SEPs require the same
preparation and level of consistency as an SP,
and are helpful to guide the scenario or provide
clues that could be key to better managing or
treating the patient.
Behavioral emergency simulation activities
can also be valuable in teaching EMS provid-
ers important interprofessional communication
skills. Common scenarios include a patient
with excited delirium and/or an uncoopera-
tive patient with police involvement. Consider
a patient who’s placed prone with 2–4 police
officers on their back—a high risk for asphyxia-
tion. EMS providers have a medical lens toward
patient safety, whereas police officers have a
legal focus toward the public’s safety. This type
of interprofessional scenario can help EMS pro-
viders speak up and confront police officers to
advocate for the patient’s safety.
It might seem obvious to state that
the improper use of stretchers risks
harm to patients, but the appropriate
use of stretchers is often overlooked
during simulation activities, and rarely
do they specifically focus on their use.
From novice EMT students who
need to be taught these activities to
experienced EMS providers who need to be
reminded of the importance of proper stretcher
use, it’s simple to build this into the objectives
and assessment in simulation activities.
For example, do your assessment activities
include the proper use of all straps? Do they
include ensuring appropriate and complete
communication for all stretcher use and movement? Is all of the equipment properly secured
and able to withstand an ambulance impact?
Medication errors can contribute to patient
harm or even death and simulation activities
can support reducing or eliminating medication mistakes in at least two ways: 1) To identify
where errors occur; and 2) To develop and reinforce safe and appropriate medication administration behaviors.
Low-level use of task trainers is an excellent
way to teach early learners the basics on appropriate drug administration principles using the
six rights of medication administration. However, it’s not until medication administration is
simulation is important
within EMS education.